This paper outlines the development and construction of an ontology necessary to accurately represent the concepts of a generic enterprise, primarily in a manufacturing context, for use with a disc...

From the ethics perspective, “duty of care” is a difficult and contested term, fraught with misconceptions and apparent misappropriations. However, it is a term that clinicians use frequently as they navigate COVID-19, somehow core to their understanding of themselves and their obligations, but with uncertainty as to how to translate or operationalize this in the context of a pandemic. This paper explores the “duty of care” from a legal perspective, distinguishes it from broader notions of duty on professional and personal (...) levels, and proposes a working taxonomy for practitioners to better understand the concept of “duty” in their response to COVID-19. (shrink)

As is often the case in clinical ethics, the discourse in COVID-19 has focused primarily on difficult and controversial decision-making junctures such as how to decide who gets access to intensive care resources if demand outstrips supply. However, the lived experience of COVID-19 raises less controversial but arguably more profound moral questions around what it means to look after each other through the course of the pandemic and how this translates in care for the dying. This piece explores the interface (...) between the pandemic, ethics, and the role of palliative care. We argue that the ethical discourse should be broader, and that the principles that underly the discipline of palliative care provide a solid ethical foundation for the care of all patients through the coronavirus pandemic. (shrink)

C.S. Lewis was a major public intellectual in Britain, beginning from the late 1930s and continuing to his death in 1963. In both his non-fiction, especially The Abolition of Man, and his fiction, most importantly in That Hideous Strength, he offers a critique of rationalism and scientism that is often strikingly similar to those that Michael Oakeshott penned in the late 1940s and early 1950s. This essay examines the question to what extent this similarity is merely superficial, and to what (...) extent the two writers shared a similar basis for their views. Furthermore, it examines whether there is an actual thread of influence: had Oakeshott been reading Lewis before writing his critique of rationalism, and if so, to what extent did Lewis’s work inform Oakeshott’s? (shrink)

In his essay on paternalism and personal identity, Wilkinson draws on Derek Parfit’s Reasons and Persons (1984) to call for a reappraisal of the role of paternalism in healthcare decision-making in situations in which patients with capacity make decisions which are likely to have harmful consequences for themselves.1 The imperative to respect autonomy, coupled with JS Mill’s insistence that the state is justified in interfering with an individual’s liberty only in situations in which she harms or threatens to harm another (...) person, leaves clinicians with little room to constrain decisions in which a patient’s choice may seriously harm her. Parfit reduces personal identity to the continuity of psychological and physical traits across the lifecourse, and suggests that, since these sets of characteristics change significantly over time, it may make more sense to view a person at different time points as different ‘selves’, rather than as the same person. Parfit’s defence of paternalism involves arguing that, given this inevitable lack of continuity, causing harm to one’s future self is analogous to harming another person and that intervening to prevent this may be justifiable in accordance with the Harm Principle.2 The issue of personal identity has received considerable attention in the philosophical literature and it remains a vexed question. Parfit’s argument, along with the thought experiments on …. (shrink)

The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. (...) We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation. (shrink)

Since Mill's seminal work On Liberty, philosophers and political theorists have accepted that we should respect the decisions of individual agents when those decisions affect no one other than themselves. Indeed, to respect autonomy is often understood to be the chief way to bear witness to the intrinsic value of persons. In this book, Sarah Conly rejects the idea of autonomy as inviolable. Drawing on sources from behavioural economics and social psychology, she argues that we are so often irrational in (...) making our decisions that our autonomous choices often undercut the achievement of our own goals. Thus in many cases it would advance our goals more effectively if government were to prevent us from acting in accordance with our decisions. Her argument challenges widely held views of moral agency, democratic values and the public/private distinction, and will interest readers in ethics, political philosophy, political theory and philosophy of law. (shrink)

Effective evaluation of any activity requires, first, that we understand what its objectives are, and second, that we can define and measure these objectives. For instance, a publicly listed compan...

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not (...) been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death. (shrink)

A compelling argument for the morality of limitations on procreation in lessening the harmful environmental effects of unchecked populationWe live in a world where a burgeoning global population has started to have a major and destructive environmental impact. The results, including climate change and the struggle for limited resources, appear to be inevitable aspects of a difficult future. Mandatory population control might be a possible last resort to combat this problem, but is also a potentially immoral and undesirable violation of (...) human rights. Since so many view procreation as an essential component of the right to personal happiness and autonomy, the dominant view remains that the government does not have the right to impose these restrictions on its own citizens, for the sake of future people who have yet to exist.Sarah Conly is first to make the contentious argument that not only is it wrong to have more than one child in the face of such concerns, we do not even retain the right to do so. In One Child, Conly argues that autonomy and personal rights are not unlimited, especially if one's body may cause harm to anyone, and that the government has a moral obligation to protect both current and future citizens. Conly gives readers a thought-provoking and accessible exposure to the problem of population growth and develops a credible view of what our moral obligations really are, to generations present and future. (shrink)

Too often, we as individuals do things that harm us, that seriously interfere with our being able to live in the way that we want. We eat food that makes us obese, that promotes diabetes, heart failure and other serious illness, while at the same time, we want to live long and healthy lives. Too many of us smoke cigarettes, even while acknowledging we wish we had never begun. We behave in ways that undercut our ability to reach some of (...) our most valued goals, despite education and despite incentives to choose the right thing. What should be done?If I were to try to harm someone else in a way that alters his future seriously and perhaps irrevocably for the worse, I would be stopped. When it comes to hurting myself, though, we have a common belief that it is wrong to interfere, even if I foresee that I will very much regret what I have done, often when it is too late to fix what I have let happen. I think this makes no sense. If it is permissible, even obligatory, to stop me when I do something that seriously interferes with someone else's chances of achieving the life he wants, I think …. (shrink)

On March, 24, 2020, 818 cases of COVID-19 had been reported in New South Wales, Australia, and new cases were increasing at an exponential rate. In anticipation of resource constraints arising in clinical settings as a result of the COVID-19 pandemic, a working party of ten ethicists was convened at the University of Sydney to draft an ethics framework to support resource allocation decisions. The framework guides decision-makers using a question-and-answer format, in language that avoids philosophical and medical technicality. The (...) working party met five times over the following week and then submitted a draft Framework for consideration by two groups of intensivists and one group of academic ethicists. It was also presented to a panel on a national current affairs programme. The Framework was then revised on the basis of feedback from these sources and made publicly available online on April 3, ten days after the initial meeting. The framework is published here in full to stimulate ongoing discussion about rapid development of user-friendly clinical ethics resources in ongoing and future pandemics. (shrink)

I am grateful to the Journal of Medical Ethics for asking these critics to discuss my book, and am grateful to each of the critics themselves for raising interesting and often difficult issues for me to think about.Alan Wertheimer makes a number of good points. One of the most significant, to me, is how paternalism might function at what I will call an institutional level. In my book, I endorse paternalistic actions by the state, when the cost benefit analysis justifies (...) that. I have not supported paternalistic interventions by private individuals, though. For one thing, private individuals will make decisions without public input, and without their justification being examined by experts in the field, and for these reasons they are too likely to make mistakes as to when intervention is appropriate. For another, the interventions by random individuals haranguing us about our failure to eat our broccoli is likely to drive us crazy—unexpected interference from people with no particular authority will give us just that sense of harassment I say paternalists need to avoid.However, between the public, authorised actions of a democratic state and the private actions of individuals with no authority lies the significant area of non-state institutions. Such institutions develop regulations and standards their members are expected to act in accordance with, and these in turn can have a significant impact on private persons. Of course, there have also been legal actions, notably court decisions, that have played a role here, but much of the specific interpretation of things like consent has been determined by the medical community developing what it believes to be an appropriate ethic for itself. And we know, here, that in recent years there has been a movement away from the paternalism that was once common, and a reorientation towards respect for …. (shrink)

The right to health care is a right to care that is not too costly to the provider, considering the benefits it conveys, and is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens’ engagement in reasonable preventive health care (...) practices. (shrink)

This is a really good book. Brettschneider’s When the State Speaks is both provocative and persuasive, resolving a stubborn conflict within democratic theory in a way many will initially reject, but which he argues for so effectively that, by the end, the controversial appears the commonsensical.The problem Brettschneider addresses is one with which we are all familiar. In democracies we believe in the right to free speech. We believe that this right is implied by the underlying principles of democracy, and (...) believe that the exercise of this right is essential for democracy to function. We are presented with a conflict when some people use their right to free speech to advocate values that are contradictory to democracy: to argue that not everyone should be allowed to speak, to argue that not all citizens are equal, to argue that some people should be discriminated against for reasons of race, religion, sex, or other distinctions that, in a democracy, we hold to be irrelevant. The probl. (shrink)

I argue that it can be morally permissible to coerce people into doing what is good for their own health. I discuss recent initiatives in New York City that are designed to take away certain unhealthy options from local citizens, and argue that this does not impose on them in unjustifiable ways. Good paternalistic measures are designed to promote people's long-term goals, and to prevent them from making short-term decisions that interfere with reaching those, and New York's attempts to ban (...) the sale of sugary drinks larger than 16 ounces and the use of trans fats fall within those parameters. Given our tendency to cognitive bias, we need help in making choices that truly instantiate our values. (shrink)

It has apparently become fashionable of late to criticize utilitarianism for what is thought to be, in a word, its insensitivity. Utilitarianism is said to ignore the complexities of character of its agents, and because of this to impose upon them a burden they cannot well bear—a failure which, in the end, renders the adoption of the utilitarian goal fundamentally unappealing, since the more utilitarian agents try to maximize utility the more happiness is destroyed. More traditional criticisms have, of course, (...) centered around the issue of rights, obligations, and justice. The claim that utilitarianism must tolerate such unappealing practices as the punishment of the innocent has led many to reject it. At the same time, of course, perhaps just as many have defended it, demonstrating that no form of utilitarianism would allow much of this; some forms would allow none of it; and that lastly, and most importantly, it is question-begging to reject the theory for failing to acknowledge the existence of a thing when it is the very aim of that theory to call that existence into question. The debate over justice, although stirring, has often seemed destined to end in stale-mate. (shrink)

We describe the case of an eighty‐four‐year‐old man with disseminated lung cancer who had been receiving palliative care in the hospital and was found by nursing staff unresponsive, with clinically obvious signs of death, including rigor mortis. Because there was no documentation to the contrary, the nurses commenced cardiopulmonary resuscitation and called a code blue, resulting in resuscitative efforts that continued for around twenty minutes. In discussion with the hospital ethicist, senior nurses justified these actions, mainly citing disciplinary and medicolegal (...) concerns. We argue that moral harms arise from CPR performed on a corpse and that legal concerns about failing to perform it are unfounded. We contend that such efforts are an unintended consequence of managerialist policies mandating do‐not‐resuscitate orders and advance care plans and of defensive practices that can value the interests of institutions and practitioners over those of patients. Health management teaching should include managerialism and its pitfalls, while clinician training should prioritize ethical reasoning and legal knowledge over defensive practice. (shrink)

In Tess of the d’Urbervilles, the innocent Tess is the object of Alec d’Urberville’s dishonorable intentions. Alec uses every wile he can think of to seduce the poor and ignorant Tess, who works keeping hens in his mother’s house: he flatters her, he impresses her with a show of wealth, he gives help to her family to win her gratitude, and he reacts with irritation and indignation when she nonetheless continues to repulse his advances, causing her to feel shame at (...) her own ingratitude and confusion as to what is right. Tess, anchored both by her own sense of virtue and her distrust of Alec’s character, continues to hold out until one fatal night when, through Alec’s machinations, they are lost together in a wood. At Tess’s insistence Alec leaves her to scout out the path home. When he returns, he finds her asleep under a tree. Hardy does not go into detail at this critical juncture. Rather, he reflects “why it was that upon this beautiful feminine tissue, sensitive as gossamer, and practically blank as snow as yet, there should have been traced such a coarse pattern as it was doomed to receive; why so often the coarse appropriates the finer thus, the wrong man the woman, the wrong woman the man, many thousand years of analytical philosophy have failed to explain to our sense of order.”. (shrink)

Dans les sociétés modernes, le respect de l'autonomie est souvent considéré comme la voie royale menant à la reconnaissance de la valeur intrinsèque des personnes. Or, la philosophe américaine Sarah Conly refuse d'emprunter la voie de la sacralisation de l'autonomie. Puisant aux sources de la philosophie, de l'économie comportementale et de la psychologie sociale, elle montre plutôt le caractère irréfléchi de nos décisions et soutient en conséquence que certains de nos choix, présumés autonomes, sont en grande partie nuisibles à l'atteinte (...) de nos propres buts fondamentaux : être en santé, libre et heureux. Nous sommes des êtres rationnels, mais le sommes-nous vraiment dans notre vie de tous les jours? Croyons-nous vraiment être capables de toujours prendre les bonnes décisions? Pour Sarah Conly, dans de nombreux cas - sécurité routière, saine alimentation, retraite -, nos aspirations seraient mieux réalisées si l'Etat nous empêchait d'agir en fonction de nos seules intuitions ou convictions premières. Tel est le sens du paternalisme coercitif, dont l'auteure entend montrer les bienfaits. Une telle prise de position remet largement en question les vues habituelles sur la moralité, la démocratie ou la frontière séparant le public et le privé. (shrink)

This chapter contains section titled: What Is a Woman? “I Am a Viper Pilot” But Aren't Men and Women Different? Crossroads Notes.

Bryan Hall is dean of the College of Contemporary Liberal Studies and Professor of Liberal Arts at Regis University, USA. An Ethical Guidebook to the Zombie Apocalypse, his first foray into fiction...